TCD Nov 2012 Development and Evaluation of a Clinical Needs Assessment (CNA) used to Support Student Nurses and Midwives with a Disability Dr S. O’Toole, F. Howlin & Dr P. Halligan Development and Evaluation of a Clinical Needs Assessment (CNA) used to Support Student Nurses and Midwives with a Disability Dr S. O’Toole, F. Howlin & Dr P. Halligan Scoil Na hAtrachta, an Cnaimhseachais agus na gCoras Slainte UCD UCD School of Nursing, Midwifery and Health Systems Ireland

Introduction & Background TCD Nov 2012 Background & context Nature of disabilities Students with disabilities & third level education

Association for Higher Education and Access Disabilities (AHEAD) (2011) TCD Nov 2012

Nursing & Midwifery Students Registered with a Disability 1: 19 students Dyslexia most common Varied types of disabilities More than 1 disability UCD/SNMHS* stats:  2010/11 = 49  2011/12 = 51  2012/13 = 46 TCD Nov 2012 *UCD/SNMHS = University College Dublin/School of Nursing, Midwifery & Health Systems

Disability Profile Undergraduate Nursing & Midwifery Students in UCD 2012/2013 – UCD/SNMHS Nursing /Midwifery Students Nursing /Midwifery Students Specific learning disabilities 31 Significant ongoing illness 6 Mental health 3 ADD/ADHD3 Hearing impairment 1 Visual impairment 1 Physical disability 1 Autistic spectrum disorder 0 Other0 Unspecified0 TCD Nov 2012

Aim developmentevaluation Present the development and evaluation of a Clinical Needs Assessment (CNA) for Nursing and Midwifery students clinical practice with a disability in clinical practice TCD Nov 2012

Phase 1 – Review Review of current academic needs assessment Discussion of core competencies:  UCD/SNMHS  Access centre disability team  Key clinical stakeholders  Experts who support and advise people with disabilities (AHEAD & SKILL) TCD Nov 2012

Phase 2 – Exploration Exploration of the accommodations  Examination of five domains and standards  Identification of core competencies Explore literature on needs assessments  Research literature  Disability support services Refinement of the draft CNA Competencies should not screen out individuals with a disability TCD Nov Professional/ Ethical Practice 2 Holistic approaches to care 3 Interpersonal relationships 4. Organization and management of care 5. Personal and professional development Domains of Competence Source: An Bord Altranais (ABA)

The Clinical Needs Assessment  Conducted by Disability Liaison Team  Individualised  Assistive Technology (AT)  Not static  Collaboration TCD Nov 2012

Clinical Needs Assessment Part 1  Background Part 2  Detailed history  Reasonable accommodations Part 3 (Clinical site)  Reasonable accommodations Part 4 (Std & Clinical site)  Review of reasonable accommodations..\..\DSS 2012\CNA\Sample of CNA Part 3.pdf..\..\DSS 2012\CNA\Sample of CNA Part 3.pdf TCD Nov 2012

Phase 3- Evaluation TCD Nov 2012 Sample (student profile) Data collection: , Interview: (semi- structured, open ended, individual, audio taped) Ethics – confidentiality and anonymity Thematic Analyses Key findings:  The Process of Disclosure  Supports  Environment  Personal Student profile [school leavers] Female (mainly) Irish Single Type of disability:  Dyslexia = 8  Mental Health =1  SOI=1 Disclosure: 7/10 3 programmes: BSc G, M, P

The Process of Disclosure TCD Nov 2012 Disclosure StaffPersonality

Process of Disclosure I don’t think that the person I was placed with [preceptor], I don’t think that she knew to be honest. I mentioned it to her a few times but a lot of people say, oh I have a difficulty in writing and stuff like that. (Int 2)...when you first go into placement there is so much to take in and you don't want to single yourself out. (Int 1) When you are on the ward there isn’t time to be discussing things like that (disclosure) (Int 3) I had a different preceptor almost every day which I found really difficult because you were constantly explaining to someone about your difficulties...(Int 3) CPC came down and explained to my preceptor that I have a learning disability and when she left, I was told by the preceptor, yes you have a learning disability but don’t become a victim about it.(Int 3) TCD Nov you didn't want to, in front of everyone say, well actually I have dyslexia, it might take me a couple of minutes to catch up. You don't want to be making an issue of it again. (Int 5)

Process of Disclosure I found that the forms that we filled out were helpful so the pressure was taken off me, we didn't have to verbally disclose, I just handed the sheets and then they could ask me questions if they needed to... (Int 5) You are not explaining yourself and getting all worked up and embarrassed and psyching yourself up to disclose (Int 5) - I decided to tell them just,... not to watch my back,... but say if something did happen at least I would know that I have told them I have dyslexia (Int 4)

Supports TCD Nov 2012 Supports Disability Awareness Receiving support

Supports TCD Nov she'd [nurse] say a big long word and I'd try and keep repeating it and then someone else might say, oh can you grab this when you are in there as well (Int 4)...I kind of felt when that [CNA] was done there was a lot of things mentioned that didn't really happen. There wasn’t much put in place if you know what I mean. (Int 3)...And the nurses were really good like they'd quiz you and you are kind of put on the spot and you feel a bit like, oh oh, when someone is throwing a question at you. You just have to get on with it and its probably better that you have to try (Int 2)

Supports... Definitely the CPCs coming down... and go through things with me, different clinical issues and stuff like that that I wouldn't have been aware of before... she would just take a bit of time if she had it to go through things. And I just wanted to say it was absolutely fantastic (Int 3) I didn't find there was any difficulties as such only when it came to reading... a handover sheet and some of the words I just hadn't a clue how to pronounce, I didn’t even know where to start pronouncing them. That would have been difficult. (Int 4) I didn’t really have any problems as far as dyslexia (Int 2) When I was on placement a few things happened that could have knocked me back, that could have made me ill again…I got upset one day in clinical placement and my CPC came to me and made me a cup of tea and calmed me down and was someone to talk to. And I found that was really, really helpful for me. (Int 5) I found the support of the other students, knowing someone else was going through the same thing...really helpful...they can understand what you are saying to them.(Int 5)

Environment TCD Nov 2012 Environment Nature of the ward Documentation Staffing Support

Environment TCD Nov they are all so busy and not everyone remembers or whatever...I found in some situations the nurses just didn’t have the time to take us on, and in your first placement, you take a little more time, you know, you don’t know how to do everything when you first go to the ward. Sometimes the nurses would be like; oh I will do it, instead of taking the time to teach you or whatever. (Int 2) But I found that interview [Occ health] really terrible, it was really stressful... a terrible experience. I came out nearly in tears, it was dreadful... he [DR]was very blunt and not sensitive to my disability. But at the same time I think what he was trying to do was to see how far he could go before I cracked, to see if I would be able for the pressure of nursing... knock my confidence and it did take me a while... I was questioning myself again was I actually able for this course, was I able for this nursing? (Int 5) I had a different preceptor almost every day which I found really difficult because you were constantly explaining to someone about your difficulties and then there was no consistency about what you were learning and you were nearly starting from scratch every day …my fault was not really telling people (Int 3)

Personal TCD Nov 2012 Personality Communication Self strategies

Personal TCD Nov 2012 I'd bring them [list of words] on placement with me so I'd flick through them (Int 3)...unless you are really confident enough to go up to your preceptor and say, can I have a word with you, you are not ever going to be by yourself with her….I never actually got the opportunity to just say it to her ( Int 1) you know what you are able to do and what you are not able to do...(Int 1) At the start though I found the communication with the patients difficult...because when I was coming from school where you are always looking up to someone else; whereas when you go into clinical placement, they are looking up to you and they expect you to know; like the roles have completely shifted (Int 4) Just don’t want to be making a big issue all the time (Int 3)

Conclusion The CNA bridges the gap in provision of student support between the academic and clinical environment The communication re student accommodations between academia and clinical areas requires further improvement Experience of students were mixed re disclosure and supports received Environment played a major role in the experience of disclosure and support. Consideration needs to be given to the environment and its impact on these areas. Recognize that supports are not unilateral but interdependent between clinical, academia and the student TCD Nov 2012

Relevance to Clinical Practice TCD Nov 2012 Ongoing disability awareness training for all professionals and incorporate into all education programs. This will ensure that staff are up to date and have the necessary knowledge and skills in providing disability support Educate students with a disability re the transition to clinical practice (i.e. terminology, word pronunciation, abbreviations) Improve communications between academic and clinical areas re accommodations and support Continue to monitor the provision of supports to ensure that students needs are fully met Seek ways to conduct research into larger populations (i.e. students with different disabilities and from all professions) Disseminate findings from evaluations to all who support students with a disability

TCD Nov 2012 Thanks to, clinical partners, colleagues and students Special thanks to AHEAD and UCD Access Centre for their support Further information: Frances Howlin Phil Halligan Acknowledgements

TCD Nov 2012